DOI: 10.17343/sdutfd.1846547 ISSN: 1300-7416

Evaluation of Latent and Active Tuberculosis Development in Patients Receiving Biologic Agent Therapy: A Retrospective Analysis

Pınar Mutlu, Işıl Deniz Alıravcı
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Objective To determine the incidence of active TB in patients re- ceiving biological/tsDMARD therapy and to examine the effects of LTBI prophylaxis and the level of immu- nosuppression on risk. Material and Method Patients aged ≥18 years who started biological treat- ment between 2019 and 2024 were reviewed retro- spectively. Inclusion criteria: ≥3 months of biological/ tsDMARD use, at least one LTBI test (PPD or IGRA) performed before the treatment, and ≥6 months of fol- low-up records. Exclusions: previous active TB, miss- ing baseline data, or follow-up at an external center. Demographics, diagnosis, agent type/duration, addi- tional immunosuppression, BCG scar, LTBI screening results, prophylaxis regimen, and adverse events were recorded. The primary endpoint was defined as active TB. The relationship between LTBI treatment, level of immunosuppression, LTBI positivity, and active TB was examined using Bayesian logistic regression. Results A total of 101 patients were reviewed. PPD was per- formed in 69.1% and IGRA in 51.5% of patients; BCG scar was observed in 93.8%. Two cases of active TB (2.0%) were observed: one developed under barici- tinib and the other under bevacizumab. The LTBI pro- phylaxis completion rate was 71.2%, and hepatotox- icity was 11.9%. Bayesian analysis revealed a high but uncertain risk association with LTBI treatment (OR 57.65; 95% CrI 0.93-3303.16), which was consistent with indication confounding. The likelihood of higher risk was 78% in the low-moderate immunosuppres- sion group. No independent effect of LTBI positivity was observed. Conclusion Active TB under biological/tsDMARD therapy is rare but important. The high risk seen in those receiving LTBI prophylaxis may be a result of clinicians select- ing high-risk patients rather than the treatment itself. The findings achieved in this study suggest that cau- tion is necessary with JAK inhibitors and anti-angio- genic agents and should be confirmed by larger pro- spective studies.

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